A systemic autoimmune disease that affects the entire body
Sjögren’s (“SHOW-grens’) is a systemic autoimmune disease that affects the entire body. Along with symptoms of extensive dryness, other serious complications include profound fatigue, chronic pain, major organ involvement, neuropathies, and lymphomas. Today, as many as four million Americans are living with this disease.
Sjögren’s can be challenging to recognize or diagnose because symptoms may mimic those of menopause, drug side effects, or medical conditions such as lupus, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, and multiple sclerosis and thus makes receiving a prompt diagnosis difficult.
As a systemic disease affecting the entire body, symptoms may remain steady or worsen over time. There is not one single progression of the disease, and this can make it challenging for patients and their physicians. While some people experience mild discomfort, others suffer debilitating symptoms that greatly impair their functioning. Early diagnosis and proper treatments are important as they may prevent serious complications and greatly improve a patient's quality of life.
About half of the time Sjögren's occurs alone, and the other half occurs in the presence of another autoimmune connective tissue disease such as Rheumatoid Arthritis, Lupus, or Scleroderma.
In addition, Sjögren's is often misrepresented as a rare disease, however, it is estimated that four million Americans are living with this disease, making it one of the most prevalent autoimmune diseases.
Symptoms vary from person to person but may include:
Neurological problems, concentration/memory loss, “brain fog”, dysautonomia, headaches
Dry eyes, corneal ulcerations, and infections
Dry nose, recurrent sinusitis, nosebleeds
Dry mouth, mouth sores, dental decay, difficulty with chewing, speech, taste, and dentures
Swollen, painful parotid/salivary glands
Difficulty swallowing, heartburn, reflux, esophagitis
Fatigue, vasculitis, lymphoma, dry skin, skin sensitivity to UV light
Recurrent bronchitis, interstitial lung disease, pneumonia
Arthritis, joint/muscle pain
Abnormal liver function tests, chronic active autoimmune hepatitis, primary biliary cholangitis
Peripheral neuropathy, Raynaud’s
Stomach upset, gastroparesis, autoimmune pancreatitis
Irritable bowel, autoimmune gastrointestinal dysmotility
Interstitial cystitis, interstitial nephritis including renal tubular acidosis, glomerulonephritis
Vaginal dryness, vulvodynia; chronic prostatitis
How is Sjögren's Diagnosed?
There is no single test that will confirm the diagnosis of Sjögren's and thus physicians must conduct a series of tests and ask about symptoms the patient is experiencing.
Rheumatologists have primary responsibility for diagnosing and managing Sjögren's and can conduct a series of tests and ask about symptoms. Your eye doctor or an oral medicine specialist also might run tests if Sjögren's is suspected.
Physicians will use several tests and questions to determine a Sjögren's diagnosis. These tests may include some of the following:
-A (or Ro) and SS-B (or La): Marker antibodies for Sjögren’s. 70% of Sjögren’s patients are positive for SS-A and 40% are positive for SS-B. Also found in lupus patients.
-Schirmer test: Measures tear production.
-Rose Bengal and Lissamine Green: Uses dyes to examine the surface of the eyes for dry spots.
-Salivary Flow: Measures the amount of saliva produced over a certain period of time.
-Salivary Gland Biopsy (usually in the lower lip): Confirms lymphocytic infiltration of the minor salivary glands.
Questions used in diagnosis may include:
-How long have you been experiencing dry eyes?
-Do you have a foreign body sensation in your eye?
-How often do you use artificial tears each day?
-How long have you had a dry mouth?
-Do you experience salivary gland swelling?
-Do you need liquids to swallow food?
In addition to objective and subjective testing, your physician will also take a complete medical history as well as discuss the various symptoms you may be experiencing. Your physician will then consider the results of all these tests and his/her examination to arrive at a final diagnosis.
A Sjögren’s patient’s treatment path should be decided on a case-by-case basis after the potential benefits and side effects are weighed by patients and their healthcare providers. Since Sjögren’s affects each patient differently, a personalized plan should be developed by you and your physician, dentist, eye care provider, and other specialists about how to treat your various symptoms.
In some cases, lifestyle changes can help certain symptoms such as fatigue and gastrointestinal reflux, and over-the-counter products can help alleviate symptoms such as dryness. Sjögren’s patients are often managed with a combination of strategies, over-the-counter products, and prescription drugs. Most patients will need prescription medications at some point to help control their disease and reduce the potential for complications.
Several different medications are available that can be used to manage symptoms. Currently, no single medication has been conclusively proven to slow the progression of Sjögren’s or treat all aspects of the disease. Please see your primary care physician if you think you have any of these symptoms for a full exam and assessment.
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